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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201243
Report Date: 08/09/2024
Date Signed: 08/09/2024 12:44:58 PM


Document Has Been Signed on 08/09/2024 12:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:VILLA NUEVA CARE HOME 1FACILITY NUMBER:
079201243
ADMINISTRATOR:PERDIGUERRA, MYLINFACILITY TYPE:
740
ADDRESS:2130 DORSCH ROADTELEPHONE:
(510) 512-4368
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
08/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Administrator Fe DimaanoTIME COMPLETED:
12:55 PM
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On 8/9/2024 at 8:55 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to complete the Post Licensing Inspection started on 8/7/2024. Upon entry, LPA stated the purpose of the visit to Administrator Fe Dimaano.

The LPA reviewed facility records, records of 5 residents, and records of 5 staff members.

No citations were issued during the inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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